The unvarnished truth about race discrimination in the NHS

The first report of the Workforce Race Equality Standard has set a baseline for all NHS trusts in England, exposing disparities in the treatment of black and white staff. In the best performing organisations, staff and managers are working together and achieving real progress.

Posted 07 October 2016 - 06:00

The first report of the Workforce Race Equality Standard has set a baseline for all NHS trusts in England, exposing disparities in the treatment of black and white staff. In the best performing organisations, staff and managers are working together and achieving real progress

When NHS England chief executive Simon Stevens launched the first report of the NHS Workforce Equality Standard in June, he described the findings as unvarnished feedback to every hospital and trust about the experiences of their black and minority ethnic staff. The findings, based on the 2015 staff survey, reveal that in most NHS organisations there remains a painfully wide gap between the rhetoric on equal opportunities and the reality.

In three quarters of acute trusts BME staff were more likely than

...

The first report of the Workforce Race Equality Standard has set a baseline for all NHS trusts in England, exposing disparities in the treatment of black and white staff. In the best performing organisations, staff and managers are working together and achieving real progress

An inaugural report into the relationship between race
and treatment of NHS staff has exposed disparities. Picture: IStock

When NHS England chief executive Simon Stevens launched the first report of the NHS Workforce Equality Standard in June, he described the findings as ‘unvarnished feedback’ to every hospital and trust about the experiences of their black and minority ethnic staff. The findings, based on the 2015 staff survey, reveal that in most NHS organisations there remains a painfully wide gap between the rhetoric on equal opportunities and the reality.

In three quarters of acute trusts BME staff were more likely than white staff to report being harassed, bullied or abused by staff; in almost 9 out of 10 acute trusts (86%), BME staff were less likely to believe their organisation offered equal opportunities for career progression or promotion in comparison with while staff; and more than 8 out of 10 acute trusts reported that BME staff were more likely to have personally experienced discrimination from a manager, team leader or colleague than white staff.

These findings might sound – indeed, are – depressing. But the glass half full version is that at least they are now out in the open, and give the NHS something to build on for the future. As the introduction to the report says, you can’t change what you don’t know.

Mr Stevens appears to be taking the optimistic view. ‘As this is the first year of the WRES, it provides a transparent baseline from which each employer will now be seeking to improve.’

The WRES requires NHS employers to demonstrate progress against indicators of equality for white and BME staff, such as the percentage of shortlisted candidates appointed to posts, the likelihood of receiving non-mandatory training, the percentage being bullied, and representation of BME staff on the board.

RCN Diversity and Equalities Co-ordinator Wendy Irwin says the WRES report confirms what many BME care support workers have been saying for years - ‘that their experience of the workplace is profoundly affected by their race across a wide-range of dimensions.

‘The impact of racism can be felt in terms of accessing their first nursing roles and non-mandatory learning and development and developing their careers through promotion’. She adds that it is up to employers to tackle ‘this enormous waste of talent and skill as a matter of urgency’.

NHS England plans to publish the WRES results annually, and £2 million has been set aside to identify and share good practice, building on what trusts are trying to do to improve recruitment, board membership, disciplinary action, and bullying of NHS staff.

There are good examples out there – such as the workshops set up by Barts Health NHS Trust to improve the promotion chances to BME and female staff (see below). This is also a priority for North East London NHS Foundation Trust (NELFT). As one of the first trusts to implement an ethnic minority strategy, its work is now gaining recognition and winning awards.

Wellington Makala, the trust’s deputy director, associate board member and BME ambassador says staff must have ‘a level of understanding about one another in order to work together effectively’. ‘This is supported by our chief executive [John Brouder] who has made clear his personal commitment to this agenda in ensuring NELFT is fair for everyone; this to him is not an option but a requirement.’

Concrete steps include electing ethnic minority field ambassadors, whose role will include supporting non-BME managers who manage BME staff, and supporting individuals going through grievances or disciplinary professes. A BME conference is to be held in November, and a mentoring and reverse mentoring scheme involving the executive management team is also under way – meaning BMA staff have access to role models in senior roles, while senior managers can also learn from experiences of BME staff.

The trust has a five year strategy in place and this year is trying to maintain the reduction in bullying and harassment cases, as well as focus on fair recruitment.

Across the country, Ms Irwin would like to see WRES act as a springboard for greater collaboration between employers and staff side. ‘The value of such initiatives is greatly enhanced when it generates a real, substantive and practical partnership working between employers and trade unions,’ she adds.

She says there is no doubt about the scale of issues faced by BME nurses and healthcare support workers and therefore no room for complacency. ‘There needs to be an urgency in terms of seeking and implementing a clear and evidence-based programme of reform to bring this discrimination to an end.’

Barts Health NHS Trust: action that made a difference

The shocking reality of its own employment statistics was one of the factors that convinced Barts Health NHS Trust that it had to take action to improve the work prospects of people from BME backgrounds.

Although based in East London, which has one of the most ethnically diverse areas of the country, and with around half its workforce coming from BME backgrounds, this wasn’t reflected in senior management positions. ‘In our trust BME staff made up 50% of staff in the lowest-paid positions, compared to 20% among the highest pay brackets, says Karlene Akindele, from the organisational development team. ‘We are determined to change this.’

A workshop dedicated to improving the aspirations and attainment of women and people from BME backgrounds was one response. Now in its second year, it has seen an impressive 21 members of staff (out of 150) promoted within a year of completing the course. In all but one of the 12 completed cohorts members of staff have gone on to apply for and be promoted to a new role at a higher banding. Of the 21 promotions, 16 were secured at the trust, whilst 5 people chose to move on to other NHS organisations.

Launched in 2015, each cohort member participates in three workshops covering personal effectiveness, career planning and job interview skills. It is fast growing in popularity with nurses and midwives, says a trust spokeswoman. Thirteen nurses and a midwife are signed up to participate in this autumn’s cohorts, building on the 40 nurses and 15 midwives who completed the course last year.

The workshops were only the beginning. The organisational development team has also created a BME Development Steering Group which produced a film (see below), funded by NHS England, to highlight the journey, challenges and aspirations of BME staff.

Aiming to be a catalyst for change, the film now accompanies training information in an app and a facilitator’s guide to train people managers and host discussions about the issues raised in the film. It is hoped to encourage positive change and the adoption of a new shared vision putting equality at the heart of recruitment.

Key to the success has been securing leadership buy-in: this year the trust board has included addressing under-representation of female and BME staff at senior levels in the organisation’s annual objectives.

The workshops aren’t just about getting promotion, a trust spokeswoman adds: ‘Other participants overcame psychological barriers to achieve life-long aspirations such as passing their driving test and studying towards qualifications.’

Top tips on making equality initiatives work include:

Secure senior leadership buy-in

Work in partnership with established staff side groups with a wide range of staff from the initial stage